Adrenal insufficiency--an unusual cause of shock in postoperative patients.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
P SabharwalM J Breslow

Abstract

To remind physicians that adrenal insufficiency can cause postoperative shock and that the manifestations are difficult to distinguish from those of sepsis. We present detailed case reports of three patients who had hyperdynamic shock in the surgical intensive-care unit and describe their response to the cosyntropin stimulation test. All three patients were diagnosed as having adrenal insufficiency with use of the cosyntropin stimulation test. Two of the three patients rapidly recovered; however, because of delay in the diagnosis of adrenal insufficiency, the third patient succumbed to multisystem organ failure. The cases presented highlight the need to exclude adrenal insufficiency as a possible cause of hyperdynamic circulatory shock, particularly when no clear-cut diagnosis exists. Early recognition of adrenal insufficiency is important and can result in reversal of shock and prevention of death. Adrenal insufficiency can be diagnosed through screening random cortisol levels and by use of the cosyntropin stimulation test. Patients in addisonian crisis often respond to the first dose of glucocorticoid with dramatic improvement in blood pressure and systemic vascular resistance. Administration of glucocorticoid can thus lead t...Continue Reading

References

Mar 1, 1975·Annals of Surgery·C A HubayR P Levy
Jan 31, 1976·British Medical Journal·H KehletP Rasmussen
Mar 1, 1988·Critical Care Medicine·R I Dorin, P J Kearns
May 1, 1988·The Journal of Experimental Medicine·R BertiniP Ghezzi
Jun 1, 1993·Archives of Surgery·W A Baldwin, M Allo

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Citations

Jul 12, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Julie E Goodwin, David S Geller
Dec 2, 2014·Critical Care Clinics·Eliezer L BoseMichael R Pinsky
Jul 1, 2006·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Jyothi Tirumalasetty, Leslie C Grammer

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Addison Disease

Addison's disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones. Discover the latest research on Addison's disease here.

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